Metformin

Monotherapy or in combination w/ other oral antidiabetic agents or w/ insulin for type 2 DM in adults when dietary management & exercise alone does not result in adequate glycaemic control. In children >10 yr & adolescents, may be used as monotherapy or in combination w/ insulin. Reduction of diabetic complications in overwt type 2 diabetic adults treated w/ metformin as 1st-line therapy after diet failure.

Adult w/ normal renal function (GFR ≥90 mL/min) Monotherapy & combination w/ other oral antidiabetic agents Initially 500- or 850 mg bd-tds, adjusted based on blood glucose measurements after 10-15 days. Max: 3 g daily in 3 divided doses. Transfer from another oral antidiabetic agent Discontinue the other agent & initiate as indicated. Combination w/ insulin Initially 500- or 850 mg bd-tds, adjust insulin dose based on blood glucose measurements. Children & adolescent Monotherapy & combination w/ insulin Initially 500- or 850 mg once daily, adjusted based on blood glucose measurements after 10-15 days. Max: 2 g daily in 2 or 3 divided doses. Patient w/ renal impairment (GFR 60-89 mL/min) Max: 3,000 mg daily in 2-3 divided dose, (GFR 45-59 mL/min) Max: 2,000 mg daily in 2-3 divided dose, (GFR 30-44 mL/min) Max: 1,000 mg daily in 2-3 divided doses.